Journal of Neurosurgery: Spine
Volume 40: Issue 3 (Mar 2024)
Images from Özer and Demirtaş (pp 351–358).

Spine - 1 year subscription bundle (Individuals Only)

USD  $392.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $636.00
USD  $392.00
USD  $636.00
Restricted access

In Brief

Researchers assessed whether there are any distinctions between long cervical and cervicothoracic constructs that utilize an upper instrumented vertebra (UIV) at C2 versus the subaxial spine (C3/C4). The key finding of this study revealed that constructs with a UIV in the subaxial spine were associated with a higher risk of proximal adjacent-segment disease and subsequent reoperation. This observation may offer valuable insights for optimizing preoperative planning in patients undergoing long posterior cervical and cervicothoracic fusions.

Restricted access

In Brief

It has been hypothesized that cervical foraminal stenosis affecting the spinal nerves results in changes in the multifidus and rotatores muscles. The results of this study demonstrated level- and side-specific correlations between fatty infiltration of the multifidus and rotatores muscles and severity of cervical foraminal stenosis. Given the segmental innervation of these muscles, the authors hypothesize that the increased fatty infiltration could be reflective of changes due to muscle denervation from cervical foraminal stenosis.

Free access

In Brief

Researchers used a large administrative database to follow patients longitudinally after single-level cervical disc arthroplasty and anterior cervical discectomy and fusion. In contradiction to the available data from cervical disc replacement randomized control trials, no difference out to 10 years was found in the cervical reoperation rates between the two procedures. This is the largest long-term outcome data study to compare the two procedures as they are actually used in clinical practice.

Restricted access

In Brief

This study aimed to investigate how sarcopenic obesity (SO) influences the surgical outcomes of spinal metastasis patients. The authors found that SO was associated with increased likelihood of nonhome discharge, more 30-day readmissions, and higher postoperative mortality. This research highlights the importance of considering SO when developing care plans for spinal metastasis surgery. These novel findings introduce SO as a meaningful factor in spine oncology and surgery outcomes.

Restricted access

In Brief

Previous studies on enhanced recovery after surgery (ERAS) have focused on degenerative spinal diseases (DSDs). With iterative implementation of the comprehensive ERAS protocol in all spinal surgical procedures, including those for primary spinal tumors (PSTs), the authors found that the protocol was universally effective, with a pronounced length of stay reduction in the PST group and cost reduction in the DSD group. This study underscores the rationale for implementing ERAS across all spinal surgical procedures.

Restricted access

In Brief

Researchers used epigenetic clocks and telomere length to assess biological age in patients who underwent elective spinal deformity surgery. They found that biological age was associated with markers of frailty and disability, whereas patients with postoperative complications had shorter telomere length. These data suggest a potential role for biomarkers as a component of preoperative surgical risk assessment.

Restricted access

In Brief

The authors aimed to identify risk factors for proximal junctional kyphosis (PJK) and proximal junctional failure (PJF), including paraspinal muscle atrophy in adult spinal deformity (ASD) surgery. This study found that erector spinae atrophy was more significant in the PJK/PJF group compared with the control group, especially in the PJF group. These results suggest that paraspinal muscle atrophy should be evaluated in ASD surgery.

Restricted access

OBJECTIVE

Diabetes mellitus (DM) is a known risk factor for postsurgical and systemic complications after lumbar spinal surgery. Smaller studies have also demonstrated diminished improvements in patient-reported outcomes (PROs), with increased reoperation and readmission rates after lumbar surgery in patients with DM. The authors aimed to examine longer-term PROs in patients with DM undergoing lumbar decompression and/or arthrodesis for degenerative pathology.

METHODS

The Quality Outcomes Database was queried for patients undergoing elective lumbar decompression and/or arthrodesis for degenerative pathology. Patients were grouped into DM and non-DM groups and optimally matched in a 1:1 ratio on 31 baseline variables, including the number of operated levels. Outcomes of interest were readmissions and reoperations at 30 and 90 days after surgery in addition to improvements in Oswestry Disability Index, back pain, and leg pain scores and quality-adjusted life-years at 90 days after surgery.

RESULTS

The matched decompression cohort comprised 7836 patients (3236 [41.3] females) with a mean age of 63.5 ± 12.6 years, and the matched arthrodesis cohort comprised 7336 patients (3907 [53.3%] females) with a mean age of 64.8 ± 10.3 years. In patients undergoing lumbar decompression, no significant differences in nonroutine discharge, length of stay (LOS), readmissions, reoperations, and PROs were observed. In patients undergoing lumbar arthrodesis, nonroutine discharge (15.7% vs 13.4%, p < 0.01), LOS (3.2 ± 2.0 vs 3.0 ± 3.5 days, p < 0.01), 30-day (6.5% vs 4.4%, p < 0.01) and 90-day (9.1% vs 7.0%, p < 0.01) readmission rates, and the 90-day reoperation rate (4.3% vs 3.2%, p = 0.01) were all significantly higher in the DM group. For DM patients undergoing lumbar arthrodesis, subgroup analyses demonstrated a significantly higher risk of poor surgical outcomes with the open approach.

CONCLUSIONS

Patients with and without DM undergoing lumbar spinal decompression alone have comparable readmission and reoperation rates, while those undergoing arthrodesis procedures have a higher risk of poor surgical outcomes up to 90 days after surgery. Surgeons should target optimal DM control preoperatively, particularly for patients undergoing elective lumbar arthrodesis.

Restricted access

In Brief

Utilizing the Michigan Spine Surgery Improvement Collaborative database, the authors investigated risk factors for failure to improve to a noticeable degree after elective lumbar spine surgery. They observed that longer duration of symptoms and previous spine surgery were the greatest risk factors for bad outcome, in addition to social determinants of health (race and education level) and chronic opiate use. This information is valuable to help surgeons counsel their patients about the probability of success after surgery and set realistic expectations for surgery.

Free access

In Brief

This study demonstrates that unilateral biportal endoscopic discectomy (UBE) is a safe and effective alternative to traditional lumbar microscopic discectomy (LMD) for treating lumbar disc herniation. UBE offers benefits such as shorter hospital stay and reduced postoperative pain while maintaining high patient satisfaction. This research contributes valuable insights into minimally invasive spine surgery techniques, aiding clinicians in making informed treatment decisions.

Restricted access

In Brief

Researchers used a smartphone application to prospectively collect data from obese and nonobese patients undergoing full endoscopic spine surgery. The aim was to evaluate potential differences between the groups since obese patients have shown inferior results in traditional spine surgery. The study showed no differences in short-term outcomes and perioperative complications. Thus, full endoscopic spine surgery has the potential to close the gap in primary and secondary outcomes for obese patients after spine surgery.

Restricted access

In Brief

The authors analyzed the independent risk factors affecting postoperative quality of life using the minimal clinically important difference (MCID) as the quantifying tool. The nomogram model was constructed to predict the risk of patients failing to reach the MCID after the correction of ankylosing spondylitis (AS) and thoracolumbar kyphosis (TLK) with pedicle subtraction osteotomy. Additionally, the personalized sagittal reconstruction strategy was established based on pelvic incidence and thoracic inlet angle. The findings of this study help provide an important reference for preoperative planning of spinal osteotomy in treating AS with TLK.

Restricted access

In Brief

Researchers conducted a systematic review of the treatment options available for Tarlov cysts. Conservative, percutaneous, and surgical approaches are discussed. The authors provide expert opinion and propose a treatment algorithm for the management of Tarlov cysts.

Restricted access

In Brief

The role of standard MRI in spinal dural arteriovenous fistula is mainly limited to the detection of perimedullary flow voids and spinal cord edema. The authors explored the success of standard MRI features to locate the side and site of arteriovenous shunts. The results are promising to complement spinal MR angiography and spinal digital subtraction angiography in locating the side and site of shunts in the management of spinal dural arteriovenous fistula.

Restricted access

In Brief

Researchers evaluated surgical smoke hazards during spine surgery by measuring particulate matter (PM) and formaldehyde (HCHO) levels. A significant amount of various sizes of PM and HCHO was generated by electrocautery, and simply applying an adjacent suction tip decreased the PM level. This study showed the possible occupational hazards to spine surgeons related to surgical smoke, which was previously unknown.

Restricted access

TO THE EDITOR: We were intrigued by the article by Greenberg et al., which presents a comprehensive review of the technology, analytical considerations, and applications of mobile health (mHealth) tools for evaluating patients undergoing spine surgery (Greenberg JK, Javeed S, Zhang JK, et al. Current and future applications of mobile health technology for evaluating spine surgery patients: a review. J Neurosurg Spine. 2023;38[5]:617-626). Their paper highlights the importance of smartphones as a commonly available form of mHealth technology that can provide information related to activity, sleep, and social interactions. However, we have certain concerns

Restricted access

In Brief

The Michigan Spine Surgery Improvement Collaborative studied whether a history of anxiety and depression had any association with poorer outcome after elective spine surgery. They found a significant association between a history of anxiety or depression with negative clinical outcome. In addition, there was an additive effect with a history of both anxiety and depression in several outcomes. This finding should help surgeons in managing expectations in this patient population.

Open access

In Brief

This prospective multicenter randomized study aimed to compare SpineJack and brace treatments in acute traumatic vertebral fractures. There was no difference in terms of visual analog scale scores. SpineJack treatment was associated with better radiological outcomes, shorter hospital stays, faster return to work, and fewer hours of nursing care. As the first prospective randomized study, this study provides valuable medical and economic information to guide clinicians in their therapeutic choices.

Restricted access

OBJECTIVE

Emergency department visits 90 days after elective spinal surgery are relatively common, with rates ranging from 9% to 29%. Emergency visits are very costly, so their reduction is of importance. This study’s objective was to evaluate the reasons for emergency department visits and determine potentially modifiable risk factors.

METHODS

This study retrospectively reviewed data queried from the Michigan Spine Surgery Improvement Collaborative (MSSIC) registry from July 2020 to November 2021. MSSIC is a multicenter (28-hospital) registry of patients undergoing cervical and lumbar degenerative spinal surgery. Adult patients treated for elective cervical and/or lumbar spine surgery for degenerative pathology (spondylosis, intervertebral disc disease, low-grade spondylolisthesis) were included. Emergency department visits within 90 days of surgery (outcome measure) were analyzed utilizing univariate and multivariate regression analyses.

RESULTS

Of 16,224 patients, 2024 (12.5%) presented to the emergency department during the study period, most commonly for pain related to spinal surgery (31.5%), abdominal problems (15.8%), and pain unrelated to the spinal surgery (12.8%). On multivariate analysis, age (per 5-year increase) (relative risk [RR] 0.94, 95% CI 0.92–0.95), college education (RR 0.82, 95% CI 0.69–0.96), private insurance (RR 0.79, 95% CI 0.70–0.89), and preoperative ambulation status (RR 0.88, 95% CI 0.79–0.97) were associated with decreased emergency visits. Conversely, Black race (RR 1.30, 95% CI 1.13–1.51), current diabetes (RR 1.13, 95% CI 1.01–1.26), history of deep venous thromboembolism (RR 1.28, 95% CI 1.16–1.43), history of depression (RR 1.13, 95% CI 1.03–1.25), history of anxiety (RR 1.32, 95% CI 1.19–1.46), history of osteoporosis (RR 1.21, 95% CI 1.09–1.34), history of chronic obstructive pulmonary disease (RR 1.19, 95% CI 1.06–1.34), American Society of Anesthesiologists class > II (RR 1.18, 95% CI 1.08–1.29), and length of stay > 3 days (RR 1.29, 95% CI 1.16–1.44) were associated with increased emergency visits.

CONCLUSIONS

The most common reasons for emergency department visits were surgical pain, abdominal dysfunction, and pain unrelated to index spinal surgery. Increased focus on postoperative pain management and bowel regimen can potentially reduce emergency visits. The risks of diabetes, history of osteoporosis, depression, and anxiety are areas for additional preoperative screening.

Restricted access

TO THE EDITOR: We read with great interest the article by Pennington et al., which analyzed the risk of pathologic fracture following radiotherapy for mobile spine metastases (Pennington Z, Mikula AL, Lakomkin N, et al. Comparison of Hounsfield units and vertebral bone quality score for the prediction of time to pathologic fracture in mobile spine metastases treated with radiotherapy. J Neurosurg Spine. 2024;40[1]:19-27). They revealed that lower Hounsfield units (HU) and higher Spine Instability Neoplastic Scores are associated with increasing odds of pathologic fractures. We would like to point out some concerns regarding this

Restricted access

OBJECTIVE

The impact of mental health comorbidities on outcomes after lumbar spine surgery in workers’ compensation (WC) patients has not been robustly explored. The goal of this study was to examine the impact of mental health comorbidities on pain, disability, quality of life, and return to work after lumbar spine surgery in WC patients.

METHODS

A nationwide, prospective surgical outcomes registry (National Neurosurgery Quality Outcomes Database [N2QOD]) was queried for all patients who underwent 1- to 4-level lumbar decompression and/or fusion from 2012 to 2021. Patients were stratified on the basis of compensation status into non-WC (25,507) and WC (1018) cohorts. Baseline demographic data, perioperative safety data, and patient-reported outcome measures were compared between groups. The WC cohort was further subdivided on the basis of mental health status into patients with anxiety and depression (n = 107) and those without anxiety and depression (n = 911). Propensity matching was used to generate parity between these subgroups, generating 214 patients (107 pairs) for analysis. Perioperative safety, facility utilization, 1-year patient-reported outcomes (back and leg pain, disability, and quality of life), and return to work were measured as a function of WC and mental health comorbidity status.

RESULTS

A total of 26,525 patients (25,507 non-WC and 1018 WC) who underwent 1- to 4-level lumbar spine surgery were reviewed. WC patients were younger, healthier (lower American Society of Anesthesiologists class), more likely to be minorities, less educated, and more likely to smoke and had greater baseline back pain, disability, and quality of life compared to non-WC patients. The prevalence of anxiety and depression was similar between groups (11%). WC patients had worse outcomes for all measures and lower rates of return to work compared to non-WC patients. WC patients with anxiety and depression demonstrated even greater disparities in all outcomes. After propensity matching, WC patients with anxiety and depression continued to demonstrate significantly worse outcomes in comparison to WC patients without anxiety and depression.

CONCLUSIONS

Disparities in outcomes after lumbar spine surgery in WC patients are exacerbated in patients with anxiety and depression. WC patients with mental health comorbidities receive the least benefit from lumbar spine surgery and may represent the most vulnerable subset of patients with spine pathology. Addressing mental health comorbidities preoperatively may represent an opportunity for valuable resource allocation and surgical optimization in the WC population.

Restricted access

In Brief

The authors analyzed a newly developed tether pedicle screw (TPS) to evaluate the ability to soften force transition cranial to long fusions to prevent proximal junctional kyphosis (PJK). TPSs were able to generate a smoother motion discontinuity at the upper instrumented vertebra. TPSs are newly developed implants. They allow for individual stepless pretensioning of the rod in the screw head and might be beneficial to prevent PJK.

Restricted access

In Brief

This study aimed to isolate and assess the relationship between race and short-term postoperative outcomes in patients who underwent elective single-level lumbar fusion. A coarsened exact matching protocol revealed that non-White patients experienced higher rates of nonhome discharge, emergency department visits, and readmissions compared to White patients despite having no differences in intraoperative complications. These findings suggest the presence of underlying structural factors that should be examined and targeted with future risk-mitigation strategies.

Restricted access

In Brief

By using simulations of deformity corrections based on the alignment obtained during the procedure within the fusion, this study demonstrated that undercorrection is a major factor resulting in distal junctional kyphosis failure.

Restricted access

OBJECTIVE

Cervical spondylotic myelopathy (CSM) can cause significant difficulty with driving and a subsequent reduction in an individual’s quality of life due to neurological deterioration. The positive impact of surgery on postoperative patient-reported driving capabilities has been seldom explored.

METHODS

The CSM module of the Quality Outcomes Database was utilized. Patient-reported driving ability was assessed via the driving section of the Neck Disability Index (NDI) questionnaire. This is an ordinal scale in which 0 represents the absence of symptoms while driving and 5 represents a complete inability to drive due to symptoms. Patients were considered to have an impairment in their driving ability if they reported an NDI driving score of 3 or higher (signifying impairment in driving duration due to symptoms). Multivariable logistic regression models were fitted to evaluate mediators of baseline impairment and improvement at 24 months after surgery, which was defined as an NDI driving score < 3.

RESULTS

A total of 1128 patients who underwent surgical intervention for CSM were included, of whom 354 (31.4%) had baseline driving impairment due to CSM. Moderate (OR 2.3) and severe (OR 6.3) neck pain, severe arm pain (OR 1.6), mild-moderate (OR 2.1) and severe (OR 2.5) impairment in hand/arm dexterity, severe impairment in leg use/walking (OR 1.9), and severe impairment of urinary function (OR 1.8) were associated with impaired driving ability at baseline. Of the 291 patients with baseline impairment and available 24-month follow-up data, 209 (71.8%) reported postoperative improvement in their driving ability. This improvement seemed to be mediated particularly through the achievement of the minimal clinically important difference (MCID) in neck pain and improvement in leg function/walking. Patients with improved driving at 24 months noted higher postoperative satisfaction (88.5% vs 62.2%, p < 0.01) and were more likely to achieve a clinically significant improvement in their quality of life (50.7% vs 37.8%, p < 0.01).

CONCLUSIONS

Nearly one-third of patients with CSM report impaired driving ability at presentation. Seventy-two percent of these patients reported improvements in their driving ability within 24 months of surgery. Surgical management of CSM can significantly improve patients’ driving abilities at 24 months and hence patients’ quality of life.

Restricted access

OBJECTIVE

Depression has been implicated with worse immediate postoperative outcomes in adult spinal deformity (ASD) correction, yet the specific impact of depression on those patients undergoing minimally invasive surgery (MIS) requires further clarity. This study aimed to evaluate the role of depression in the recovery of patients with ASD after undergoing MIS.

METHODS

Patients who underwent MIS for ASD with a minimum postoperative follow-up of 1 year were included from a prospectively collected, multicenter registry. Two cohorts of patients were identified that consisted of either those affirming or denying depression on preoperative assessment. The patient-reported outcome measures (PROMs) compared included scores on the Oswestry Disability Index (ODI), numeric rating scale (NRS) for back and leg pain, Scoliosis Research Society Outcomes Questionnaire (SRS-22), SF-36 physical component summary, SF-36 mental component summary (MCS), EQ-5D, and EQ-5D visual analog scale.

RESULTS

Twenty-seven of 147 (18.4%) patients screened positive for preoperative depression. The nondepressed cohort had an average of 4.83 levels fused, and the depressed cohort had 5.56 levels fused per patient (p = 0.267). At 1-year follow-up, 10 patients still reported depression, representing a 63% decrease. Postoperatively, both cohorts demonstrated improvement in their PROMs; however, at 1-year follow-up, those without depression had statistically better outcomes based on the EQ-5D, MCS, and SRS-22 scores (p < 0.05). Patients with depression continued to experience higher NRS leg scores at 1-year follow-up (3.63 vs 2.22, p = 0.018). After controlling for covariates, the authors found that depression significantly impacted only 1-year follow-up MCS scores (β = 8.490, p < 0.05).

CONCLUSIONS

Depressed and nondepressed patients reported similar improvements after MIS surgery, except MCS scores were more likely to improve in nondepressed patients.

Restricted access

In Brief

Limited research has been conducted on the clinical characteristics and outcomes of isolated spinal aneurysms (ISAs). The authors performed a comprehensive analysis of ISAs at their institutions and found a potential correlation between the morphology of the ISAs and their underlying causes. Furthermore, their findings suggested that saccular ISAs observed in young patients may be remnants of spinal cord arteriovenous shunts. This study offers novel insights into the etiology of ISAs.

Restricted access

In Brief

This study was performed to identify the risk factors of adjacent-segment disease after short fusion for de novo degenerative lumbar stenosis. The authors found that disc wedging angle greater than 2.5°, presence of facet tropism, and foraminal stenosis greater than grade 2 preoperatively at the adjacent level to the fusion were risk factors for adjacent-segment disease. Therefore, one should consider including the segment with these pathologies within the fusion.

Restricted access

In Brief

This study aimed to evaluate the safety and efficacy of surgical interventions within 24 hours versus after 24 hours for the management of acute traumatic central cord syndrome (ATCCS). The key findings suggest that early surgery (≤ 24 hours) may offer advantages, particularly in terms of lower complication rates, though improvements in American Spinal Injury Association motor scores were not significantly different compared to surgical procedures performed later (> 24 hours). This study adds value to the ongoing debate regarding the optimal timing for surgical intervention in ATCCS, highlighting the potential benefits of earlier surgery and emphasizing the need for further research to elucidate clinical implications.

Restricted access

OBJECTIVE

Degenerative spine conditions affect many people each year. These conditions have been shown to negatively impact pain, function, and patient quality of life (QOL), which often require surgical intervention. It is understood that sleep plays an important role in all of these factors. However, the relationship between sleep disruption and lumbar surgery is not well understood. The objective of this study was to use a large database to understand the relationship between sleep quality and lumbar spine surgery outcomes.

METHODS

The surgical database of the authors’ institute was used to identify all patients undergoing lumbar spine surgery for degenerative spine disease from January 1, 2012, through December 31, 2021. Patient-Reported Outcomes Measurement Information System (PROMIS) sleep disturbance scores were collected, and only patients with both pre- and postoperative scores were included. Additional measures related to disability, pain, and depression were also obtained. Chart review was performed to collect patient demographics, health risk factors, and information related to sleep disturbances such as sleep medication usage and prior sleep condition diagnosis.

RESULTS

The study had 674 patients who met the criteria. At 3, 6, and 12 months postoperatively, there was a significant decrease in sleep disruption scores (i.e., sleep improvement), although these decreases were not greater than the minimal clinically important difference (MCID). When stratified based on preoperative sleep quality, patients with poor preoperative scores (PROMIS sleep disruption > 63.04) showed a significant decrease in sleep disruption by 8.17 at 3 months, 7.99 at 6 months, and 7.21 at 12 months. All of these decreases were greater than the sleep disruption MCID of 6.5. Multivariate analysis showed high preoperative sleep disruption and improvement in PROMIS physical health were most associated with decreased postoperative sleep disruption at all postoperative time points.

CONCLUSIONS

In patients with degenerative spine conditions, lumbar spine surgery offers improvement in sleep disruption for all patients. Those with poor preoperative sleep quality are more likely to see clinical improvement in their sleep disruption.

Restricted access

In Brief

This study aimed to assess the influence of the connection levels and rod configuration of the accessory rod (AR) on rod fracture occurrence in patients with adult spinal deformity who underwent long level constructs and pedicle subtraction osteotomy. The authors' findings revealed that the D-shaped configuration of AR and lower end of AR below S1–2 (i.e., long AR) can be preventive methods for reducing rod fracture. Here, they have provided the first comprehensive outline for the AR technique.

Restricted access

In Brief

This study retrospectively compared outcomes and complications between patients with upper instrumented vertebrae at L4 and L5 when correcting pediatric L5–S1 spondylolisthesis. The authors found that fusion to L5 is as effective as extension to L4, though there was a higher chance of adjacent-segment instability. This suggests that extending fusion to L4 might not be crucial, offering new insights for future treatment strategies.

Restricted access

In Brief

The purpose of the present study was to modify and validate the Clavien-Dindo-Sink complication classification system for applications in spine surgery. The proposed classification system demonstrated excellent inter- and intrarater reliability in spine surgery cases. This modified classification system provides a useful framework to better communicate the severity of spine-related complications.

Restricted access

In Brief

The goal of this study was to identify the effect of surgery within 8 hours in older patients with cervical spinal cord injury (CSCI). Urgent surgery within 8 hours for patients older than 70 years who had CSCI did not increase the perioperative complication rate and improved the American Spinal Injury Association motor scores. Urgent surgery within 8 hours for older patients with CSCI need not be avoided due to the risk of perioperative complications and may be desirable for a favorable neurological prognosis.

Restricted access

OBJECTIVE

Both the Global Alignment and Proportion (GAP) score and Roussouly classification account for the lordosis distribution index (LDI), but the LDI of the GAP score (G-LDI) is typically set to 50%–80%, while the LDI of the Roussouly classification (R-LDI) varies depending on the degree of pelvic incidence (PI). The objective of this study was to validate the ability of the G-LDI to predict mechanical complications and compare it with the predictive probability of R-LDI in patients with long-level fusion surgery.

METHODS

A total of 171 patients were divided into two groups: 93 in the nonmechanical complication group (non-MC group) and 78 in the mechanical complication group (MC group). The mean age of the participants was 66.79 ± 8.56 years (range 34–83 years), and the mean follow-up period was 45.49 ± 16.20 months (range 24–62 months). The inclusion criteria for the study were patients who underwent > 4 levels of fusion and had > 2 years of follow-up. The predictive models for mechanical complications using the G-LDI and R-LDI were analyzed using binomial logistic regression and receiver operating characteristic analyses.

RESULTS

There was a significant correlation between R-LDI and PI (r = −0.561, p < 0.001), while there was no correlation between G-LDI and PI (r = 0.132, p = 0.495). In reference to G-LDI, most patients in the non-MC group were classified as having alignment (72, 77.4%), while the MC group had an inhomogeneous composition (aligned: 34, 43.6%; hyperlordosis: 37, 47.4%). The agreement between the G-LDI and R-LDI was moderate (κ = 0.536, p < 0.001) to fair (κ = 0.383, p = 0.011) for patients with average or large PI, but poor (κ = −0.255, p = 0.245) for those with small PI. The areas under the curve for the G-LDI and R-LDI were 0.674 (95% CI, 0.592–0.757) and 0.745 (95% CI, 0.671–0.820), respectively.

CONCLUSIONS

The R-LDI, which uses a PI-based proportional parameter, enables individual quantification of LL for all PI sizes and has been shown to have a higher accuracy in classifying cases and a stronger correlation with the risk of mechanical complications compared with G-LDI.

Restricted access

In Brief

Researchers aimed to quantify pre- and postoperative paraspinal muscular variation following posterior lumbar interbody fusion (PLIF) in patients with degenerative lumbar spinal stenosis (DLSS) and measure the association of this variation with adjacent-segment degeneration (ASD). Compensatory postoperative decrease in fatty infiltration of the psoas major muscle at the adjacent level was a protective factor for ASD in DLSS patients after PLIF.

Restricted access

In Brief

The purpose of this study was to explore the effect of multiple social factors on postoperative outcomes and satisfaction in patients undergoing surgery for cervical spondylotic myelopathy. The effect of social factors is additive in that patients with a higher number of factors are less likely to improve compared to those with only one social factor. The social context of patients is an important factor to consider when discussing expectations and outcomes for surgery.

Restricted access

Social media platforms have taken a prominent role in healthcare for both patients and providers in various areas of medicine, including spine surgery. Patients increasingly use social media to learn about their condition, find treatment options, and research the surgeon entrusted with their care. The latter has incentivized surgeons to enhance their online presence in nonprofessional (e.g., Facebook, Instagram, and X [formerly known as Twitter]) as well as professional (e.g., LinkedIn) platforms. Nearly all spine surgeons now have an account in social media. Furthermore, a more ubiquitous presence on social media correlates with a higher rating

Restricted access

In Brief

The purpose of the study was to determine if the presence of myelography dye affects HU measurements of bone density on CT studies. The results showed that the presence of myelography dye had no clear effect on CT HU measurements of bone density, thus supporting the use of CT myelograms for bone density assessment in the absence of standard CT images.

Restricted access

In Brief

Spine surgeons are at increased risk of work-related musculoskeletal disorders (MSDs). The authors assessed the rate of MSDs and comfort in the use of surgical instruments in an anonymous survey of a diverse cohort of spine surgeons. The study reports a high rate of MSDs and a persistent gender-based difference in comfort in instrument use. These findings can guide efforts to mitigate MSDs and promote surgeon-centered approaches to instrument development.

Restricted access

OBJECTIVE

Cadaveric and dry 3D model-based simulation training is a valuable educational tool for neurosurgical residents. Such simulation training is an opportunity for residents to hone technical skills and decision-making and enhance their neuroanatomy knowledge. The authors describe the growth and development of the Oregon Health & Science University Department of Neurological Surgery resident-focused, hands-on, spine-simulation surgery courses and provide details of course evaluations, layout, and setup.

METHODS

A four-part spine surgical simulation series, including two human cadaveric and two dry 3D model-based courses, was created to provide resident spine procedure training. Residents participated in the spine simulation series (2017–2021) and completed annual course curriculum and anonymous post-course evaluations. Evaluations included both Likert scale items and free-text responses. Responses to Likert scale items were analyzed in Python. Free-text responses were quantified using the Valence Aware Dictionary for Sentiment Reasoner. Descriptive statistics were calculated and plotted using Python’s seaborn and matplotlib library modules.

RESULTS

The analysis included 129 spine (occipitocervical, thoracolumbar, and spine model fusion I and II) simulation course evaluations. Likert responses demonstrated high average responses for evaluation questions (4.67 ± 0.90 and above). The average compound sentiment value was 0.58 ± 0.28.

CONCLUSIONS

This is the first time Likert responses and sentiment analysis have been used to demonstrate how neurosurgical residents positively value a hands-on spine simulation training. Simulation is an essential component of neurosurgical resident education training. The authors encourage other neurosurgical education programs to develop and leverage spine simulation as a teaching tool.

Restricted access

In Brief

This study compares outcomes after kyphoplasty in patients stratified by age and frailty assessed by the Risk Analysis Index (RAI). Frailty was found to serve as a better predictor than age for 30-day and 1-year postoperative complications following kyphoplasty. Age alone should not be used as an exclusion criterion during patient selection, and the RAI is a straightforward assessment tool to be used for patient selection, as a guide in surgical decision-making, and to better facilitate discussions with patients.

Restricted access

In Brief

This article aimed to examine the relationship between pelvic tilt changes and global compensatory parameters after adult spinal deformity (ASD) corrective surgery. The authors found that patients who had their pelvic tilt normalized postoperatively were more likely to demonstrate resolution of thoracic and lower-extremity compensatory parameters, and they also experienced lower complication rates. This study highlights the need for consideration of global compensatory mechanisms when planning ASD surgery in order to optimize realignment and ameliorate the risk of adverse outcomes.

Restricted access

In Brief

This article aimed to examine the current information on cervical spine deformity (CSD) surgery with particular emphasis on radiographic alignment, deformity morphology, perioperative optimization, and surgical strategy. Additionally, consideration of the specific patient presentation, overall physiological health state, and disease attributable morbidity is discussed to provide a more individualized approach to treatment. The authors report that the field continues to evolve, and that it is an area primed to benefit significantly from further innovation. This study provides a synopsis of current CSD knowledge and may serve as a reference and springboard for future research endeavors aimed at enhancing CSD patient care.

Restricted access

In Brief

This study investigated the impact of pelvic incidence (PI) and lumbar lordosis (LL) matching on clinical outcomes in patients undergoing one- or two-level lumbar fusions for degenerative pathology. Proper PI-LL matching in one- and two-level lumbar fusions for degenerative pathology leads to improved outcomes at the 24-month follow-up. Patients with maintained proper alignment after surgery experience continued improvement in disability levels. Surgeons should consider longer follow-up in patients in whom proper alignment was not initially achieved.

Restricted access

TO THE EDITOR: We read with interest the article by Prasse et al., 1 which concluded postoperative remote patient monitoring and communication after complete endoscopic surgery could be achieved using the SPINEhealthie app (Prasse T, Yap N, Sivakanthan S, et al. Remote patient monitoring following full endoscopic spine surgery: feasibility and patient satisfaction. J Neurosurg Spine. 2023;39[1]:122-131). However, several concerns have arisen regarding this study.

First, while we acknowledge the convenience and enhanced patient satisfaction associated with an in-app chat function for communication with healthcare providers, we are apprehensive about its potential to increase the